Help Mii!!

1
1. What's wrong?* This field is required
Press
Enter
2
1a. Choose a word/phrase that best fits this sentence: I am currently struggling with ____.* This field is required
my family
my marriage
my relationship or friendships
infidelity or cheating
my money
my job or work life
a chronic illness or injury
trouble with the law
something unexpected
a death or tragedy
my self image and/or identity
my relationship with God
i don't know... it's complicated
Press
Enter
3
2. Is anyone else involved?* This field is required
YESNO
Press
Enter
4
2a. How has your relationship with them changed?
Press
Enter
5
3. Why is this problem an issue for you?
Press
Enter
6
4. Have you dealt with this before?* This field is required
YESNO
Press
Enter
7
5. How does this issue affect you?* This field is required
Not Affected
Somewhat
Affected
Very Affected
Energy Levels
Eating Patterns
Sleeping Patterns
Home Life
Work Life
Relationships
Energy Levels
Eating Patterns
Sleeping Patterns
Home Life
Work Life
Relationships
Not Affected
Somewhat
Affected
Very Affected
Not Affected
Somewhat
Affected
Very Affected
Not Affected
Somewhat
Affected
Very Affected
Not Affected
Somewhat
Affected
Very Affected
Not Affected
Somewhat
Affected
Very Affected
Not Affected
Somewhat
Affected
Very Affected
1 of 6
Press
Enter
8
6. Pick the best statement that describes how you feel.* This field is required
What does your mind constantly revert to?
What does this issue make you want to do?
What do you wish you had more?
How would you like to see this situation resolved?
Press
Enter
9
7. What places trigger strong emotions for you concerning this?* This field is required
Press
Enter
10
8. How do you feel about yourself as it relates to this?* This field is required
I'm not ____ enough
I deserve it
I blame myself
I'm a failure/ I'm useless
I'm a bad person
No one cares about me
I hate myself
I'm not as blessed as others
I should be better than I am
Something's wrong with me
Nothing ever works out for me
Press
Enter
11
9. What would need to change in order for you to get past this?* This field is required
Press
Enter
12
10. Choose three (3) words from the following list that best describe the needs you feel are not being met for you & make you the most upset.* This field is required
Acceptance
Understanding
Control
Attention
Peacefulness
Order
Safety
Fun
Respect
Being Needed
Be right
Comfort
Balance
Predictability
Feel Included
New challenges
Independence
Press
Enter
13
Receive Your Custom Solution
My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
Your Custom Solution
$1.99+
Back
Enter Coupon
Total: $0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Press
Enter
14
Email AddressWe would like to email your custom solution.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification.
••••
Didn't receive verification code? orReceiving the email may take a few minutes, thank you for your patience!
Press
Enter
Should be Empty: